Patient information: Multiple
pregnancy and birth
This leaflet contains advice and
guidance for pregnant women who
are expecting twins or triplets
Healthcare you can Trust
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Contents
The aim of this leaflet
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Identical and non-identical twins
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Antenatal care
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Risk of premature birth
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Adequate rest and stopping work
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Physiotherapy referral
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Care in labour
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Neonatal Intensive Care Unit (NICU)
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Feeding your babies
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‘Skin to skin’ contact
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Postnatal support
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Local and national services available to help you
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Every year we look after many mothers who are expecting
twins, and occasionally triplets. We are very aware of the
surprise (whether it be delight or total shock) that you may have
experienced when you were told that you were expecting more
than one baby.
The aim of this leaflet
Any unplanned situation has the potential to be more stressful, so
this booklet aims to give you that extra information you may need
because you are having more than one baby. This information
leaflet includes information about:
• identical and non-identical twins
• antenatal care
• care in labour
• special care baby unit
• feeding your babies
• postnatal support
At the end of the booklet you will find a list of local and national
services available to help you.
Identical and non-identical twins
Most twins are non-identical and occur when two separate eggs
are fertilised by two separate sperm. (Dichorionic diamniotic
DCDA). They can be the same or different sex and are no more
alike than brothers or sisters. There will always be two placentae
although they may be joined.
Identical twins occur when one fertilised egg splits during the
first 14 days after fertilisation. These twins are always the same
sex and have the same genetic make-up and are therefore
very similar in appearance. There is usually only one placenta.
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These twins may be in separate sacs (monochorionic, diamniotic
MCDA) or, more rarely, they may develop in the same sac
(monochorionic monoamniotic MCMA)
Antenatal care
Antenatal appointments
As you are having more than one baby the Community Midwife
or General Practitioner (GP) will book you under the care of a
hospital Consultant. During your pregnancy you will be asked to
attend the hospital Antenatal Clinic so that the hospital team can
monitor your pregnancy closely.
As well as attending the hospital regularly for antenatal checks
your GP and Community Midwife will continue to see you to
provide on-going support. They will carry out routine checks that
will include taking your blood pressure and testing your urine
for protein. Pre-eclampsia, which causes high blood pressure,
is a possible complication that is more common in multiple
pregnancies.
Folic acid and iron supplements
Anaemia is more common in a multiple pregnancy due to the
extra demands on your iron stores. Many women expecting more
than one baby need to take iron supplements. Your community
midwife will check your blood iron levels.
Antenatal screening
All screening tests will be discussed with you in detail by your
doctor or midwife. The main screening test offered to mothers
with a multiple pregnancy is a detailed scan at 18-20 weeks to
check the major physical structures of the babies.
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First trimester screening will be offered from 11 weeks and 2
days up to 14 weeks and 1 day, to assess your babies’ risk for
Down’s syndrome. This involves a scan and a blood test and is
the screening offered in twin pregnancies. This will be discussed
at your booking visit with the midwife and you will be given a
leaflet on screening. It is up to you to decide if screening is the
right choice for you.
Scans
As well as a detailed scan at 18-20 weeks, for non-identical
twins we recommend regular growth scans from 24 weeks. Your
partner or supporter is welcome to attend these scans. We do try
to coordinate your scans with your antenatal clinic visits where
possible.
Growth scans measure the size of the babies’ abdomens and
heads to assess their individual growth, and the volume of
amniotic fluid (water) around them. The blood flow through the
babies’ umbilical arteries may also be measured. These scans
check that each baby is growing well.
Monochorionic (identical) twins will need more frequent scans
than dichorionic (non-identical) twins because of the risk of
twin-to-twin transfusion syndrome. Although not common, if this
problem does occur, your pregnancy needs to be monitored very
closely by a fetal medicine consultant. For more information,
please refer to the patient information leaflet on twin-to-twin
transfusion syndrome.
Risk of premature birth
The average length of a pregnancy is 37 weeks for twins and 33
weeks for triplets. We recommend that you prepare your bags
to bring into hospital for you and your babies by 34 weeks (or 28
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weeks if carrying triplets) in case you go into labour early.
Steroid injections will be recommended to help mature your
babies’ lungs if you show any signs of premature labour or if your
consultant thinks your babies may need early delivery. These
injections reduce the risk of breathing difficulties after birth.
Many twins born before 36 weeks need admission to a Neonatal
Intensive Care Unit (NICU). Mothers with a multiple pregnancy
sometimes need to be transferred to other local or regional
hospitals for delivery if the babies are very premature and/or the
local NICU is full. The babies are often then transferred back to
the local NICU as soon as possible and will usually need to stay
there until near your original due date.
Adequate rest and stopping work
Adequate rest is very important if you have a multiple pregnancy.
Many women feel ready to stop work between weeks 26-30. You
may want to try to arrange some time in the day for a rest to help
you cope with possible tiredness, breathlessness, backache and
swollen ankles. If you have other children, it might help to draw
up a list of people who could help you care for them.
If you don’t have family or friends locally, try to find time to meet
other mums through a local playgroup, mother and toddler group
or twins club. Your health visitor will have a list of local groups.
Physiotherapy Referral
Backache and pelvic joint discomfort are common in multiple
pregnancies because of increased hormone activity and the
rapidly increasing weight you are carrying. Information leaflets
are available in the hospital antenatal clinic. If your problems are
becoming severe, it is important that you discuss them with your
midwife or doctor as you may need to see a physiotherapist.
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It is important to remember to do your pelvic floor exercises. The
extra weight you are carrying puts added strain on the pelvic floor
muscles and if they are not strengthened by exercise they may
become weak and allow leakage from your bladder.
Care in labour
Towards the end of your pregnancy the obstetric team in
charge of your care will decide with you the best time for you
to have your babies. This will depend on how your pregnancy
is progressing. You may go into labour naturally or you may be
offered induction of labour after 37/38 weeks. Induction may be
offered because you will probably be carrying much more weight
than most mothers at 40 weeks.
Many mothers having twins will give birth vaginally but there is
a chance that you may need to have a caesarean section. You
will have plenty of opportunity to discuss the options for the
birth of your babies at your hospital clinic visits. If the first baby
(twin 1) is coming head first, it is usual to recommend to try for
a vaginal birth. However, if twin 1 is breech (bottom first) or in
any position other than head first at the time of delivery, then a
caesarean section will be recommended as the safest option.
Your consultant will discuss this with you.
Due to the very big risks involved with labour and vaginal delivery
for each of the babies, a caesarean section will usually be
advised for identical twins sharing the same sac or for triplets.
When you think you are in early labour or if your waters have
broken, you are advised to contact the hospital at the earliest
opportunity. It is recommended that your babies’ heartbeats
are monitored closely throughout labour to check that both are
coping well with the contractions.
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There are different types of pain relief that are available
and these will be discussed with you. Epidurals are often
recommended in labour in preparation for the birth of your
second baby, who may need to be helped into a better position
for delivery. There will be extra midwives and medical staff in
your labour room at the time of delivery to help look after you,
your partner and your babies.
At the time of the birth you may need to have a hormone drip
in your arm (an intravenous infusion). The hormone is called
oxytocin and makes your womb contract. This will ensure your
contractions remain strong for the birth of your second baby and
will help prevent heavy blood loss afterwards.
There is a very small chance that a caesarean section will be
necessary for the delivery of your second baby even if your first
baby is born vaginally.
Neonatal Intensive Care Unit (NICU)
Babies are admitted to the NICU for several reasons, the most
common being:
• The babies have been born prematurely: this means
being born before 36 weeks. The babies’ organs may not
be fully mature and this can sometimes mean that they
find breathing, feeding and keeping warm more difficult
initially. Extremely premature babies may be transferred to
a neighbouring unit with Neonatal Intensive Care facilities.
However, in most cases mothers will be transferred before
the birth occurs.
• The babies are smaller than they should be for their age:
small babies (less than 2 kg at birth) often find feeding an
effort and are admitted to be fed by intravenous drip or
naso-gastric tube.
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• The babies have breathing difficulties: sometimes some of
the fluid which is in the baby’s lungs whilst in the womb is
still in there after birth, causing the baby to make grunting
noises and require oxygen therapy.
If your babies need admission to the Neonatal Intensive Care
Unit you, your partner and any brothers and sisters can visit them
at any time and you are encouraged to spend as much time as
you can with your babies. You will be given full information on
their condition and on any treatment they need. If your babies are
transferred to another regional NICU, arrangements will be made
for you to accompany them.
Some babies need to stay in NICU for just a few hours and
others need to stay for a number of weeks. The babies must
be feeding well, able to keep themselves warm in a cot and
be gaining weight adequately before they go home. Twins are
normally kept together but if they are ready for discharge at very
different times, the staff on NICU will help you decide what to do.
Feeding your babies
It is up to you to decide how to feed your babies and you will be
given advice and support for whichever method of feeding you
choose. Your community midwife will give you written information
about feeding your babies and will discuss it with you.
‘Skin-to-skin’ contact
Both breast- and bottle-feeding mothers are encouraged to
have ‘skin-to-skin’ contact with their babies soon after the birth,
wherever possible. Even if your babies go to NICU, you can still
do this at a later time.
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Postnatal support
If available, you will be offered a side room or extra space beside
your bed on the postnatal ward to give you more room for your
babies. Extra help and support with feeding will also be given by
the midwifery staff, but the more your partner can be present in
the first few days to help you, the better.
It will also be helpful to you if your partner can make sure you are
not overwhelmed with visitors for the first few days as it can be a
wonderful but very tiring time.
Do let your family and friends know that you may need some
help, both before and after the babies arrive. When help is
offered, be specific about what help you need. Talking to other
mums with multiple births may help to reduce any anxieties you
may have, so contact a twins group (see page 11) or ask your
midwife if she knows another mum with twins or triplets with
whom she can put you in touch.
Postnatal depression is more common in mums with multiple
births so it is very important that you or your partner tell your
midwife, GP or health visitor if you are feeling low. They will then
offer you extra support. Consider paid help, if only short term,
particularly if you have no family locally. Health visitors may be
able to advise you on other sources of help.
Many mothers of twins and triplets say they feel better if they
manage to get out of the house for a short walk with their babies
in a pram or buggy each day, weather permitting.
Fatigue can cause you to feel irritable and make you lose your
sense of humour. For this reason you are advised to rest when
you have the chance. Partners and grandparents can be an
enormous support at this time by staying calm and encouraging.
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Local and national services available to help you
Twins Club
Email: [email protected]
National Childbirth Trust (N.C.T.) Breastfeeding Line
8am-10pm, 7 days a week: 0300 3300771
Association of Breastfeeding Mothers
9.30am-10.30pm, 7 days a week: 08444 122949
Twins & Multiple Birth Association (TAMBA)
0870 7703305
www.tamba.org.uk Email: [email protected]
TAMBA Confidential Helpline (Twinline)
Freephone 0800 1380509
Weekdays 7pm-10pm
Weekends 10.00am-10pm
Multiple Birth Foundation
02083 833519 – only zygosity testing available at present but a
range of publications are available at www.multiplebirths.org.uk
Twin-to-Twin Transfusion Syndrome Association
www.twin2twin.org
Bliss
0870 7700337 – National Charity for the newborn, specialising in
premature births
www.bliss.org.uk.
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Contact telephone numbers:
Monday-Thursday 9am-5pm and Friday 9am-1pm:
• Antenatal clinic
• Antenatal reception
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01225 824659
01225 824645
Date of publication: June 2014
Ref: RUH MAT/017
© Royal United Hospital Bath NHS Trust